How does the presence of gross or microscopic hematuria affect the evaluation of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Any patient with gross or microscopic hematuria should undergo urologic evaluation, as hematuria is the most common clinical manifestation in patients presenting with bladder cancer. [64]  All patients with gross hematuria should undergo a hematuria workup consisting of a cystoscopy, computed tomography (CT) urogram, and cytology. In patients with microscopic hematuria (≥3 red blood cells per high-power field), the American Urological Association (AUA) guideline recommends stratification as low, intermediate, or high risk to determine the workup strategy. High-risk patients undergo the standard evaluation of cystoscopy with CT urogram. Intermediate-risk patients are evaluated with cystoscopy and renal ultrasound. Low-risk patients undergo repeat urinalysis in 6 months. [65]

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